Download Fad Diets to modulate Obesity - World Association for Sustainable

20/07/16
Fad Diets to modulate Obesity: Models
of unsustainable miracles
Dr Ihab Tewfik
BSc (Hons.);MPH;DrPH;PhD;RNutr(PH);FRSPH;FHEA
Programme Leader Human Nutrition (UG)- Accredited by Association for Nutrition - UK
Division of Food, Nutrition and Public Health
University of Westminster
115, New Cavendish Street, London W1W 6UW
T: +44 (0)207 915 5496 F: +44 (0)208 368 0257
E: [email protected]
Registered Nutritionist (Public Health)
Fellow of the Royal Society of Public Health
Fellow of the Higher Education Academy
Editor Int. J. Food, Nutrition & Public Health
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‘Thank You’ to all my Nutrition colleagues who
helped me to put together this summary:
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Andrew Gray
Debora De Barros Faggioni
Erika Sivonen
Hardip Deol
Hifsa Iqbal
Gabriela Dimitriu
Giuseppe Scapellato
Iman Reffas
Jomana Khawandanah
Maggie Depiero
Maria Ahmad
Nastazia Solomonidou
Samihah Hussain
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In today’s talk
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Definition and background of a fad diet
Types of fad diets with examples
Health/Psychological/ media effects of fad diets
Advantages and disadvantages of fad diets
Sustainability of fad diets
Professional health bodies
Government public health initiatives
Conclusion
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Background
As the rates of *globesity and its co-morbidity continue to
rise, people are more susceptible than ever to different fad
diets, which claim to help lose weight fast!!!
*24% of men and 26% of women over 16 years are obese in
the UK. In the UK, the average BMI for men rose from 24.1 in 1975 to 27.4 in 2014. For women, BMI went from 23.4 to
27. A BMI of 18.5 to 24.9 is considered ideal for an adult. The rise for both sexes was about 1kg/m2 each decade, although that
slowed to about 0.5kg/m2 from 2005-14. The UK has 6.8 million obese men – the eighth highest country in the
world – and 7.7 million obese women – the eleventh highest country in the world (NHS.UK, online)
Definition of fad diet:
Fad diets promise rapid weight loss, easy weight loss and enhance
sense of well-being. These weight-reduction regimes provide shortterm results that rarely follow nutritional principles. These diets
usually involve removing a food group or consuming one type in
excess. They are not endorsed by medical evidence/profession. 5
NHS.UK,(2013).LatestobesitystatsforEnglandarealarming-HealthNews-NHSChoices.[online]Availableat:hEp://www.nhs.uk/news/2013/02February/Pages/Latest-obesity-stats-forEngland-are-alarming-reading.aspx[Accessed12Oct.2014].
According to CDC - 62% of adult Americans are overweight or obese.
More than 9 million children and teenagers are suffering overweight or obesity.
Up to 50% of younger kids have tried a diet and 90% of teenagers diet regularly.
In 2004, Americans spent $46.3 billion in weight loss products!
35% of people who start by dieting occasionally become addicted to dieting
.
(University of Colorado)
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History of fad diets:
Fads are nothing new!! It has been there for more than 216 years!
1800s the Vinegar Diet
Ø Diet included daily consumption of vinegar
Ø Potatoes drenched in vinegar
Ø To suppress hunger s/he would smoke cigarettes
1903 Horace Fletcher (chew food up to100 times) Earned the nickname "The Great Masticator",
by arguing that food should be chewed about 100 times per minute before being swallowed
1925 the Cigarette diet
Ø Lucky strike brand used the appetite suppressing power of nicotine to promote the
campaign ‘Reach for a Luck instead of a sweet’.
1930s Grapefruit diet (with every meal)
Ø Based on the principle of consuming a grape fruit with every meal
Ø Caloric intake is restricted to 800 calories per day
Ø Renamed as the ‘Hollywood diet’ followed by famous celebrities such as Kylie Minogue.
1950s Cabbage Soup Diet (10-15 pounds)
Ø Designed to be composed of a low calorie intake of cabbage soup for 7 days.
1960s Tapeworm Diet (parasite packed pill)
1970s Sleeping beauty diet !!! (sleep instead of eating)
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LesleyRotchford,H.(2014).Dietsthroughhistory:Thegood,thebadandthescary.[online]CNN.Availableat:hEp://ediYon.cnn.com/2013/02/08/health/diets-through-history/[Accessed12Oct.2014].
Characteristics of fad diet
1.  Unrealistic, promises weight loss without exercise.
2.  Certain food groups are eliminated completely or
consumed excessively; assigned as “bad” and
“good” foods such as in South Beach Diet.
3.  Encourages purchase of pills, drinks, bars.
4.  Does not inform the consumer of risks associated with
medical problems with strict rules to follow.
Webmd.com,(2014).WhyDoWeKeepFallingforFadDiets?.[online]Availableat:hEp://www.webmd.com/diet/features/why-do-we-keep-falling-for-fad-diets[Accessed12Oct.2014].
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Types of Fad Diets
There are several types of fad diets and in most cases do not comply with the
Recommended Daily Allowance (RDA) of macronutrients, as they validate
selected types of food and restrict others causing temporary weight reduction,
loss of muscles and water, not fat.
Acceptable Macronutrient Distribution Ranges for Adults
(as % of Calories) are as follows:
Protein: 10-35%
Fat: 20-35%
Carbohydrate: 45-65%
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Types of fad diets
Types of diet
Examples
Types of diet
Examples
Low CHO diets
Atkins, Dunkan diet,
South Beach
Detox Diets
The Master Cleanse
Low fat diets
Pritikin, Pasta Diet
High fat
Ketogenic Diet
Combination Diet
Fit for Life, Zone Diet
High protein
Dukan Diet,
Bodybuilder Diet
Low calorie diets
Cambridge Diet
Blood Type Diet
O, A, AB etc.
Formula diet
Slimfast
Pre-measured diets
Jenny Craig,
NutriSystem
Misc.
Sugar Busters, CHO Addicts diet, Protein Power Diet, Stillman’s
Diet, The Drinking Man’s Diet, Scarsdale Diet, Tapeworm.
BasYn,S.(2004).FadDiets.1sted.[ebook]UniversityofKentuckyDepartmentofAgriculture.Availableat:hEp://FadDiets[Accessed28Sep.2014].
BDA,(2014).[online]Availableat:hEps://www.bda.uk.com/foodfacts/detoxdiets[Accessed01Oct.2014].
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Dukan diet (low CHO diets)
1. The Attack Phase with immediate results. During this phase, the diet is
made up of 72 high-protein foods enabling quick weight loss.
2. The CRUISE Phase. This second phase is leading to the True Weight.
During this phase, the diet alternates Pure Protein days (PP phases) and
Proteins accompanied with 28 recommended Vegetables (PV phases).
3. The CONSOLIDATION PHASE. In this third phase of 10 days which prepares
for the return to a balanced diet. Monitored freedom with a target of
establishing this freshly conquered and still vulnerable ideal weight. This
phase sees the gradual return of pleasurable foods with two festive meals.
4. The STABILAZITION PHASE is based on 3 simple, concrete, easy but nonnegotiable measures.
Number one: protein on Thursdays.
Number 2: 3 tablespoons of old bran per day.
Number 3: walk for 20 minutes per day and whenever possible take the
stairs.
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Detox Diets
•  Individuals temporarily change their regular
diets and spend a period of time consuming
organic and non-processed foods and drinks.
•  It involves drinking water, juiced fruits and
vegetables and eating raw fruits and
vegetables.
•  Examples include the three-day grape juice
cleanse, the beauty detox solution and the
master cleanse.
•  There is a little evidence to support that this
diet work
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The Master Cleanse
•  Individuals consume drink 8 oz 12 glasses
of a type of lemonade per day for 10
days. The drink is a mixture of lemon
water, maple syrup and cayenne pepper.
•  NB: When tested for 4 days by an Elle’s editor, she
reported a loss of 6 lbs but she regained her previous
weight when she returned to her normal diet.
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The Zone (increased CHO diets)
•  Treat food as a drug
•  Believed to be designed to control the
expression of inflammatory genes
Remember!
•  Low fat- high CHO
Carbohydrate: 45-65%
•  40% CHO
Protein: 10-35%
Fat: 20-35%
•  30% lean proteins
•  30% fat preferably mono saturated fats
such as avocado or almonds
•  Newest addition to the zone is to
promote the consumption of omega 3
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Cambridge Diet
•  Developed in 1979 by Dr.
Alan Howard
•  Based on buying and
eating a range of mealreplacement products
(bars, soups, porridges and
shakes)
•  6 diet stages,
415-1500kcal/day
•  Balance of nutrients is
designed to produce light
ketosis
•  Continuous support from
Cambridge Consultant
Picture:hEp://www.cambridgeweightplan.com/how-cambridge-weight-planworks
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Stages – Cambridge diet
Stage 1
•  3-4 Cambridge products (max. 12 weeks)
•  Energy intake 415-615 kcal/day
Stage 2
•  3 Cambridge products, protein rich food,
milk, vegetables
•  Energy intake 810kcal/day
Stage 3
•  2 Cambridge products, calorie controlled
meals
•  Energy intake 1000 kcal/day
Stage 4
•  2 Cambridge products, calorie controlled
meals
•  Energy intake 1200 kcal/day
Stage 5
•  1 Cambridge product, calorie controlled
meals
•  Energy intake 1500kcal/day
Stage 6
•  Maintenance stage, no Cambridge
products.
•  Balanced diet
PicturefromCambridgeConsultantHeliNykanen
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Research around Cambridge diet
•  12 month weight maintenance study with 12
week Cambridge diet and controlled food
reintroduction (Lean et al., 2013)
–  Mean weight loss during Cambridge diet 16.9Kg
(SD 6.0kg)
–  12 month mean weight loss 12.4Kg
–  Subjects who had withdrawn before maintenance
stage had mean weight loss of 6.7kg after 12
months
–  After 12 week Cambridge diet subjects were not
confident that weight gain could be avoided.
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Cambridge diet- Negative effects
•  No scientific studies to support weight
loss claims
•  Expensive (weekly price from £46.62)
•  Side effects during diet
–  Cramps, hair loss, constipation,
headache, nausea, sleeping problems
•  After last stage most people fall back
to old lifestyle
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Blood Type Diet
•  Eat Right For Your Type, which was published in 1996
by Dr. Peter D’Adamo
•  Reduce inflammation, prevent metabolic problems,
prevent weight gain, increase energy and lead a
longer, healthier life. Improvement of chronic
conditions such as asthma, headaches and
heartburn. (Eat Right For Your Type, 2015)
•  Theory:
Diet tailored specifically to your blood type can help the
body to digest and absorb the food effectively, which
results in weight loss.
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Blood Type Diet
Blood Type
Breakfast
Lunch
Dinner
Snack
0
Two toasted slices of Ezekiel
bread with butter, one
banana, one pear, one apple,
and herbal tea.
Organic roast beef
(6oz), spinach salad,
apple or pineapple
slices, and water.
Small lean grilled rump
steak with roasted red
pepper, sweet
potato and onion.
Mixed fruit and herbal
tea.
Slice of cake with
herbal tea.
A
Two slices of wholegrain bread
with peanut butter and
grapefruit juice, or if preferred
coffee or herbal tea.
Vegetable soup with
two slices of
wholegrain bread
and one apple with
herbal tea.
Tofu pesto lasagna,
broccoli, frozen
yoghurt and a coffee
or herbal tea
Handful of
cherries, two plums or
rice cakes with peanut
butter.
B
Bowl of porridge made with
half water and skimmed milk
with one banana and a glass of
grape juice.
Sandwich with one
thin slice of cheese,
thin slice of turkey
breast with
mayonnaise or
mustard with green
salad.
Boiled fish with
steamed veg, fresh
fruit and a herbal tea
or coffee.
One fat free yoghurt
and a herbal tea.
AB
Puffed rice with skimmed milk
and a glass of pineapple juice.
4oz sliced turkey breast
with two slices of rye
bread, caesar
salad, two plums and
a herbal tea.
Turkey stir fry made
with turkey breast,
olive oil, broccoli,
onion, cauliflower,
carrots and
mushrooms, served
with brown rice. Mixed
fruit salad and a
decaffeinated coffee.
Two rice cakes with
cottage cheese and a
handful or grapes.
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Weightlossresources,2010
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Products:
Blood
Type Diet
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Blood Type Diet
•  No evidence to support the validity of blood
type diets (Cusack et al., 2013).
•  Despite The strong evidence on the
association between ABO blood group and
CHD risk, However there is no evidence
regarding to the diet. More research is
needed to rate the effectiveness of the
blood type diet(Wang, et al., 2014; He et al., 2012).
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Eat more - Weigh less( Low fat diets)
•  Developed for the treatment of coronary disease
•  Plant based rationale, lower density foods
•  Focuses on consumption of vegetables, grains, low fat
diary
•  Meats, high fat diary, simple sugars and alcohol are
discouraged
•  Supplementation of several micronutrients is
discouraged
•  Promotes vegetarianism
•  Argues that with this eat-all-you-want, eat-as-often-asyou-are-hungry routine, your metabolism stays the
same, or better yet, even increases.
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Atkins regime
•  More than 45 millions of Atkins diet books
sold in 40 years
•  20 million people worldwide, 3 million in the
UK (Astrup et al., 2004)
•  Weight loss, maintenance of weight loss
without hunger, good health, disease
prevention
•  Multivitamins and minerals, protein shakes
(Atkins, no date)
•  Breast cancer, colon cancer, cardiovascular
disease (Stein, 2000)
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s
• 4 phases, 4 different
CHO intake allowed
• Phase 1, CHO 20-25g
• Phase 2, CHO 25-50g
• Phase 3, CHO 50-80g
• Phase 4, CHO 80-100g
Figure 1. Macronutrients and total energy
intake of Atkins diet (Astrup et al., 2004)
Remember!
Carbohydrate: 45-65%
Protein: 10-35%
Fat: 20-35%
Length of each phase
depends on weight loss
goal.
(Atkins, no date)
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Weight loss with Atkins
Atkins book: weight loss is due to the thermogenic
effect of high fat diet
•  Depletion of glycogen store and fluid loss, 400g in
the liver + 3g of water bound to 1g of glycogen
(Wasserman, 2009)
•  Circulating ketones and high protein intake
àrestriction in energy intake (Astrup et al., 2004)
•  ↑HDL, ↓LDL, ↓triglycerides, ↓TC (Mobbs et al.,
2007)
•  Constipation, headache, ↑CVD, ↑cancer,
increased osteoclasts activity (Einsenstein et al.,
2002)
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e.g.) Low-carbohydrate and no-carb diet i.e Atkins regime
This is a popular FAD diet because rapid weight loss occurs right
away, however the main problem is that water is lost, rather
than fat which is the main aim of weight-reduction plans. Thus,
when diet is stopped the body tries to restore its fluid balance
and the weight is put back on.
Carbohydrates are the main source of fuel for the body, but when
a person is following a low-carb diet their immediate source of
energy is given by fats and proteins. When protein becomes the
main source of energy, muscle mass is lost. Additionally, due to
a limited supply of carbohydrates, fats cannot be oxidised and
they breakdown incompletely forming ketone bodies.
Accumulation of ketone bodies in the bloodstream happens as
the rate of production is higher than the rate of excretion by the
kidneys. This condition is called Ketosis which is similar to
starvation, and it can be leading to health complications.
hEp://www.nhs.uk/Livewell/loseweight/Pages/I-did-10-diets-in-50-days-and-found-NHS-weight-loss-plan-worked-best.aspx
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How Low-CHO diets produce initially greater weight loss
Reducing caloric intake by 500 kcal/day should result in a 0.45- to 0.9-kg weight loss each
week. However, low-carbohydrate, high-protein diets typically produce a 2- to 3-kg weight
loss in the first week. This added weight loss is not due to the miracle of “switching the
body’s metabolism over to burning fat stores.” It is due to a diet-induced diuresis. When
carbohydrate intake is restricted, 2 metabolic processes occur, both of which
simultaneously reduce total body water content. The first process is mobilisation of
glycogen stores in liver and muscle. Each gram of glycogen is mobilized with
approximately 2 g of water. The liver stores approximately 100 g of glycogen and muscle
has 400 g of glycogen. Mobilization glycogen stores result in a weight loss of approximately
1 kg. Patients notice this change as a reduction in symptoms of “bloating” and are very
pleased with the effect. The second process is generation of ketone bodies from
catabolism of dietary and endogenous fat. Ketone bodies are filtered by the kidney as
nonreabsorbable anions. Their presence in renal lumenal fluids increase distal sodium
delivery to the lumen, and therefore increase renal sodium and water loss.
The irrational nutrients restriction elucidated
by some fad diets could derange metabolic
homeostasis and escalate an array of health
complications.
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Physiological effects of Low-CHO,
High-Protein diets
•  ‘Ketogenic induction’ lowers CHO to <50 g day
•  Unlimited amounts of animal protein
•  Sugar consumption is not allowed
1.  Ketosis and glycogen availability
•  CHO restriction leads to fat oxidation
•  Gluconeogenisis will be increased in order to
supply glucose-dependent cells i.e RBC’s and
nervous system
Westman et al., (2007). Low-carbohydrate nutrition and
metabolism. The American journal of clinical nutrition, 86(2), pp.
276--284.
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2.Lowperformancecapacity
•  LowCHOavailabilityreducesavailable
glucose,thusthebodywillbeturningtofatas
itsmainsourceofenergy
•  PhysicaladaptaYonstousingfatintrained
individuals,notinuntrained
3.Lossofleanbodymass(LBM)
•  Typicalwithweightlossbutprevious
literatureshowedthatifsufficientamountsof
proteinareconsumed
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4.Effectsonbonehealth
•  Low-CHOpromoteurinarycalciumlossviametabolicacidosis
•  BloodacidificaYondecreasesre-absorpYonofcalcium,withan
increaseinosteoclastsandinhibiYonofosteoblasts
•  Studyconfirmedlow-CHOledtoincreaseincalciumloss
withoutincreasedCaabsorpYon
5.Effectoncardiovascularhealth
•  TypicalLCD,highproteindietsarehighindietarycholesterol
andsaturatedfat
•  Roleofiscontroversial,effectonserumcholesterolconc.isnot
determined
Reddyetal.,(2002).Effectoflow-carbohydratehigh-proteindietsonacid-basebalance,stone-formingpropensity,andcalciummetabolism.American 31
JournalofKidneyDiseases,40(2),pp.265--274
OtherconsequencesofFadRegimes
•  False Hope – fad diets make promises they can’t
keep by offering “magic bullets”
•  Feeling of failure – when the diet doesn’t work or
the dieter eats a forbidden food, he/she may feel
failure or guilt
•  Loss of Money- many products are expensive
•  Avoiding Real Change – by trying fad diets,
person who really wants or needs to lose weight is
avoiding making the changes that will promote
real weight loss for good
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Psychological implications
Constant dieting is associated with a variety of
symptoms, such as:
u  Food obsession
u  Distractibility
u  Irritability
u  Fatigue
u  Tendency to overeat
u  Low self-esteem
u  Depression
Polivy (1996) Psychological consequences of food restriction, Journal of the
American Dietetic Association, 96 (6), 589-592.
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* Overeating can cause the dieter to become
overweight or obesity, when you go back to
your regular lifestyle.
* Type II diabetes
* Heart disease
* Depression
* Reduced sex drive
* Fainting
* Sinus problems (especially post-nasal drip)
* Muscle loss
* Rashes
* Gallbladder disease
* Loose folds of skin
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Are fad diets sustainable?
Scientific evidences confirmed that limiting food choices make fad diets
unmanageable, unsustainable and could potentially cause micronutrients
deficiencies, lean tissue waste, depletion of glycogen from muscle and liver
stores, increased CVD and cancer risks.
As a consequence, once the individual goes back to the usual eating pattern
and a positive energy balance is re-established, weight gain will occur.
90-95 per cent of people that go
on a diet, will not only get that
weight back but will add more
weight back because they are so
happily eating again that they do
not eat intelligently.
Familydoctor.org, (2014). Nutrition for Weight Loss: What You Need to Know About Fad Diets -- FamilyDoctor.org. [online] Available
at: http://familydoctor.org/familydoctor/en/prevention-wellness/food-nutrition/weight-loss/nutrition-for-weight-loss-what-you-need35
to-know-about-fad-diets.html [Accessed 11 Oct. 2014].
Are fad diets sustainable? BBC Diet Trials
Months
hEp://www.ncbi.nlm.nih.gov/pmc/arYcles/PMC1473108/
Only5-10%offaddietersmanagetomaintaintheirweightlosslongterm(Franz,2001).
Franz, M. (2001). The Answer to Weight Loss Is Easy—Doing It Is Hard!. Clinical Diabetes, 19(3), pp.105--109.
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Reasons for failure
•  Unsustainable
•  Only focus is on food, can become
obsessive
•  Behavioural change is not addressed
•  Too expensive
•  Not flexible with day to day lifestyle
•  Boring food
•  Lowers basal metabolic rate
http://andreatibaduiza.wordpress.com/2013/03/03/95-failure-rate/
Thomas, S., Hyde, J., Karunaratne, A., Kausman, R., Komesaroff, P. and others, (2008). They all work... when you stick to them":
A qualitative investigation of dieting, weight loss, and physical exercise, in obese individuals. Nutr J, 7(1), p.34.
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True Nutritionist's, Health advisers or GP’s will
tell you:
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Matarese et al, 40
2014
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Professional Health Bodies
•  American Heart Association
–  Fad diets are unsustainable, don’t promote
exercise, not scientifically proven
•  British Dietetic Association
–  Detox diets do not work, the body can detoxify
itself
•  Dieticians Association of Australia
–  Fad diets can make you fatter in the long run
–  In support of banning scientifically unfounded fad
diets
American Heart Association, (2014). Quick-Weight-Loss or Fad Diets. [online] Available at: http://www.heart.org/HEARTORG/
GettingHealthy/NutritionCenter/Quick-Weight-Loss-or-Fad-Diets_UCM_305970_Article.jsp [Accessed 11 Oct. 2014].
41
BDA, (2014). [online] Available at: https://www.bda.uk.com/foodfacts/detoxdiets [Accessed 11 Oct. 2014]
Dietitians Association of Austrailia, (2014). Fad Diets. [online] Available at: http://daa.asn.au/?page_id=797 [Accessed 13 Oct. 2014].
Conclusion
1.  Fad diets, as classical mode to modulate obesity is appearing to be
unsatisfactory.
2.  Weight loss cannot merely be based on aesthetic but the aspects in
response to maintenance of healthy lifestyle should be comprised.
3.  Individual should be encouraged to work towards lifelong behaviour
and dietary changes rather than “quick fixes” to lose weight.
4.  The media is commonly endorsing fad diets through magazine
articles, books and celebrity anecdotes to lose weight and become
slimmer. Subsequently, the public is becoming more self-conscious
on their weight and therefore body dissatisfaction is a rising issue
especially in adolescents and should be addressed effectively.
5.  Fad diets are unsustainable, and have high risks of failure and weight
regain
6.  Professional health bodies are trying to combat fad diets through the
promotion of balanced diets
7.  Governmental strategies are being enacted to promote healthy
Remember!
diets and ban dangerous fad diets.
Carbohydrate: 45-65%
Protein: 10-35%
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Fat: 20-35%
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